LM213 - Beyond the VNG: Basics of Advanced Vestibular Testing

Abstract:
This interactive session aims to help guide clinicians in understanding the utility of the growing body of vestibular assessment methods in the diagnosis and management of complex vestibulopathy. Relevant anatomy and physiology of the vestibular system will be reviewed, followed by a discussion of vestibular evaluation methods beyond VNG. Techniques to differentiate between central and peripheral vestibular system impairments, and methods to assess levels of compensation will be reviewed. The session will include an interactive discussion of pertinent case history and interpretation of results. Clinical case examples will be used to supplement the presentation and to synthesize the information discussed.

Summary:
Maintaining a sense of balance and equilibrium is a complex process, relying on the interpretation and integration of several sensory inputs. Accordingly, assessment of the vestibular system is complex in nature. Diagnosis and management of dizziness is often challenging, with chronic or unresolved impairments leading to negative and often significant impact on quality of life and daily functioning. Comprehensive functional assessment of the vestibular system is imperative to obtain an accurate diagnosis and to provide patients with appropriate and effective treatment plans. Technological and scientific developments have led to a number of advancements in the assessment of the dizzy patient. The expanding battery of tests available provides increasing insight into the diagnosis of vertigo and imbalance. Equipment and techniques have evolved to improve the ability to determine site of lesion, extent of impairment, and level of compensation, though many clinicians continue to rely on videonystagmography (VNG) testing as the sole indicator of a vestibular system impairment.

This presentation aims to help guide clinicians in understanding the utility of the growing body of vestibular assessment methods and tools in the diagnosis and management of complex vestibulopathy. Relevant anatomy and physiology of the vestibular system will be reviewed, followed by a discussion of vestibular evaluation methods beyond VNG. We will discuss the different elements of oculomotor, rotational chair testing, and otolith function testing to facilitate diagnosis and treatment decisions. This session will be presented in an interactive format with audience participation. Various clinical case studies will be included to provide context and facilitate discussion on the effectiveness of these techniques in clinical practice. Expected test results will be discussed in the context of underlying anatomy to differentiate between peripheral and central vestibular impairments, to determine level of compensation, and to explore the value that each measure adds to the overall test battery.